Medicalisation, morality, and addiction: why we should be wary of problem gamblers in primary care.

1 critiques of medicalisation may have become less fashionable, but no less necessary. The continuing need for a critical perspective on medicalisation is apparent at a time when the UK media displays a violent backlash against people with drink and drug problems; when the British Prime Minister defines the optimal method to 'get drug addicts clean'; 2 and when the Chair of the RCGP endorses an addiction model for addressing 'problem gambling' in primary care. 3 MEANINGS OF MEDICALISATION Medicalisation is the 'process by which non-medical problems become defined and treated as medical problems'. 4 A recent BMJ article on the subject perceived 'medicine's imperial project': the medical profession determinedly defining new diseases and broadening the diagnostic criteria of old ones (so much so that 'virtually the entire older adult population is now classified as having at least one chronic disease'). 5 However, medicalisation is frequently a more complex phenomenon than the united professional advance implied by analogies with imperialism. The processes of medicalisation may be as varied as the problems medicalised (pregnancy, 6 masturbation, 7 and repetitive strain injury 8 for example, have fascinatingly unique, and mercifully unrelated, medical histories). Furthermore, sociologist Ellie Lee has described uses of medicalisation that even the most anti-imperialist, anti-establishment agitators among us might find it difficult to disapprove of: 'battered woman syndrome' has been valuably employed in the legal defence of women who have killed their abuser; post-traumatic stress disorder (PTSD) gained benefits for unacknowledged US Vietnam war veterans in the 1980s; and a PTSD diagnosis still occasionally halts the Home Office from returning an asylum seeker to a country where they have been tortured. 9 Arguably though, the immediate gains from medical recognition of the consequences of issues such as these occur at the cost of more challenging, but ultimately more meaningful, societal recognition of their causes. Being battered by one's partner; going to war; being tortured; these are all experiences that might prompt moral discourse more appropriately than medical diagnoses; and it might reasonably be considered that they are bad things in and of themselves, quite aside from any consequent medical conditions. MEDICALISING MORALITY Morality and medicine are often entwined. Susan Sontag described the metaphors by which disease may be (im)moralised; 10 medicalisation commonly describes the means by which immorality becomes 'disease'. So, when homosexuality was 'immoral', it became made 'medical'; and 'moral' anti-abortionists tried (and failed) to show that abortion …